A Contemporary Substance Use Approach To

Drug and Alcohol Counseling: An IntroductionOne way such a relationship can transcend technique is as follows: Clients, whofor years have been isolated in addiction and reveal for the first time how sad anddepressed they have felt, can immediately begin to experience a sense of reliefand connection after sharing their torment with an understanding human being.Genuine and authentic counselors increase the likelihood of engaging with theirclients in a trusting, therapeutic relationship, which can result in clients attempting change with new behaviors (W. R. Miller & Rollnick, 2013).Counselors who are truly with clients during these low points (perhaps todepths that many people will never approach) are privileged to hear such astonishing stories. Therefore, we suggest counselors need to both realize and appreciate the courage it takes to share such pain after so much isolation. Please pausefor a moment and consider the previous message. We encourage you to reflect onthe strength, bravery, and perhaps enormous pain clients go through as they sharetheir stories. Recognize this: You are uniquely qualified to provide your distinctgifts, talents, and compassion for the human spirit.Mistaken Images of Drug- and Alcohol-Addicted ClientsWe suggest counselors assess for and then address those biases they might havewith clients who use, abuse, and are addicted to alcohol and drugs. For some counselors, the terms substance abuser, alcoholic, or addict may conjure strong negativeimages of individuals nursing inexpensive bottles of liquor wrapped in a brownpaper bag; gaunt, unkempt folks with needle marks wearing bloody clothing;or maybe young students struggling in school because of their marijuana use. Itshould be noted, however, that the majority of drug- and alcohol-addicted individuals hide their use, are indistinguishable from nonusers most of the time, andfunction in society, albeit at times under the influence.For many counselors, the field of drug and alcohol counseling harbors a challenging and perplexing population. Such a frame on the part of a counselor canmitigate the development of both a helping attitude and an open, compassionate heart. Remaining open and compassionate can be particularly difficult whenclients become angry, minimize their alcohol and drug use, or seemingly lackmotivation in treatment–goal follow-through. Without counselors developing awell-thoughtout helping attitude, clients are many times blamed and labeled asresistant. Paradoxically, such reactions by counselors typically yield an increaseddefensiveness from the client, where the resistance is in response to both the counselor and the counseling approach (here we suggest to the reader that this is similarto a self-fulfilling prophecy by the counselor). What counselors want to create isa helping attitude, which includes the following seemingly paradoxical attitudes:to be supportive yet questioning, to be unconditionally present yet at times direct,and to possess an overall attitude of realistic optimism.Establishing a Genuine Helping RelationshipA starting point may be for counselors to foster a helping attitude when workingwith clients who use and are addicted to alcohol and drugs. This is evident whenthe counselor’s personal exploration of bias has entered the therapeutic process.One example is a counselor who is angry and disgusted by a heroin-using client.This counselor, with all the desire to be helpful and effective, will have substantial3

A Contemporary Approach to Substance Use Disorders and Addiction Counselingdifficulty in developing a helping attitude. However, if this same counselor comesto understand and respect the nature of abuse and addiction and can empathizewith the client’s emotional suffering, a helping attitude is possible. Counselorsneed to maintain this respectful and helpful attitude. One way to do this is tocontinue to develop knowledge and understanding in the area of use of drugsand alcohol. For example, as counselors realize the powerful effects of narcoticscoupled with an understanding of the client’s life in relation to heroin, empathyand ongoing support on behalf of the counselor is possible (through both the goodtimes and bad moments).Another effective procedure is to unlearn previous lessons, notions, and knowledge. Start fresh with Zen Mind, Beginner’s Mind (Suzuki, 2006). This approachviews each client interaction as new and interesting. For counselors to see withfresh eyes each day, the mental approach of the beginner’s mind can also be effective in maintaining a helping attitude and demonstrating empathy. How manytimes are counselors handed a case file 3 inches thick only to be told sarcasticallyby the staff, “Good luck”? Counselors want to approach clients as if it were theirfirst time in counseling, otherwise counselor bias and prejudice ensure this assuming failure. The beginner’s mind is curious and open to all client messages andpieces of the story yet to be told. This curiosity and open-minded attitude stavesoff counselor apathy or fatigue while facilitating the development of new strategies to increase therapeutic effectiveness.First, we hope you find our writing style comfortable and that you benefit fromthe book’s construction. We’ve approached writing this text the way in which wework with clients: as genuine and as clear as possible. We’ve found that counselorsin training and counselors tend to be intimidated and fearful of working with clientswho abuse and are addicted to alcohol and drugs. Counselors in training sometimesdiscount their own skills and assets in effecting change when they are not recovering themselves. This finding is very unfortunate. In response to such concerns, webelieve we’ve created a body of information that will increase awareness and knowledge while reducing the amount of apprehension in working with this population.Significant Aspects of This BookRelapse prevention, developmental issues, spirituality, and ecological aspects oflife are significant aspects of this book. Because addiction is relapse prone, wehave devoted an entire chapter to relapse prevention. Included are methods ofworking with developmental “stuck points” during the clients’ process of gettingsober and clean. For example, approaching clients who have relapsed for the thirdtime is clinically different from working with clients who have entered treatmentfor the first time. The work of Terence Gorski (1989b) has significantly contributedto relapse-prevention treatment with addicted clients. In addition to his model,our text also takes into consideration co-occurring disorders (both emotional andphysical), environment (family and community), gender–cultural–diversity issues,and spiritual–faith–support issues. Relapse prevention focuses on connecting patterns of behavior that can lead to the use of drugs and alcohol after a period ofabstinence. Identification of patterns helps clients examine their developmentaldeficits, which contribute to relapse.Because of the significant changes in the Diagnostic and Statistical Manual ofMental Disorders–Fifth Edition (DSM-5) regarding substance abuse and addiction,4

Drug and Alcohol Counseling: An Introductionwe’ve rewritten the criteria in Chapter 4 to explain the differences between DSMIV-TR and DSM-5.Developmental life-pattern analysis, a rarely identified and explored aspect torecovery work, can contribute significantly to therapeutic planning. Clients’ lifepatterns originate from developmental deficits within the first years of life. Fromsuch origins, clients create methods of coping, which may include isolation anddisconnection. In adult life, these same coping skills impede client success in therecovery process by blocking connection with others and maintaining the disconnection from feelings.Also in this text is the intertwining of spirituality in the recovery process. Although there is some debate and disagreement by helping professionals on theissue of spirituality in the treatment of addiction, the majority of treatment centersin the United States continue to use the Twelve Steps of Alcoholics Anonymous(AA), a spiritually oriented program of recovery. The debate has led to the creationof various and varied support groups, which are highlighted in this text.In addition to relapse prevention, developmental perspectives, and spirituality,we present a community counseling approach based on the ecological model ofBronfenbrenner (1976, 1988). His approach offers a multicultural and communityperspective that can be blended with treatment and prevention planning. Whetherthose reading this text are working in schools, colleges, community–outpatientcenters, companies, or hospital settings, the information available here can be applied and used in these settings. Because counselors work in a variety of clinicalvenues and with all age groups, we’ve provided information that is specific toeach counseling genre.For Whom This Book Is Written For counselors in training. For those new to the profession and still in the process of obtaining a degree, we cover alcohol and drug clients and options fortreatment. We have provided the necessary information to effectively workin a variety of settings with clients who have addiction or substance abuseproblems. For counselors and counselors in training looking for employment in the addictiontreatment continuum. Many students, undergraduate and graduate alike, whowant to work in the alcohol and drug treatment field are not necessarily clearwhere on the substance-abuse-helping continuum they would like to work.The continuum of substance abuse care includes detoxification, intensiveoutpatient treatment, inpatient care, as well as halfway house and long-termresidential treatment. Students may also find themselves working in schoolbased assistance programs in which prevention, intervention, and educationare vital components of client care. This book outlines and describes the variety of treatment modalities in existence today and explores the specific tasksand responsibilities of each modality. For counselors currently working in drug and alcohol treatment. Current drug andalcohol counselors will find the models of recovery, approaches to relapseprevention, and information on spirituality helpful in treating clients from aholistic perspective. Because group counseling is a primary modality of alcohol and drug treatment, group counseling and the therapeutic factors thatoccur in group are presented.5

A Contemporary Approach to Substance Use Disorders and Addiction Counseling For counselors currently working in school, mental health, and college settings. Insome cases, clients may arrive for counseling services in these settings as theresult of a precipitating event not necessarily labeled drug or alcohol related.In other cases, clients may seek help specifically to discuss their drug andalcohol use. The latter group may not necessarily be motivated in discontinuing their use, but rather, they would like to cut back or control their consumption of drugs and alcohol. In either case, counselors need to understandboth the assessment process and how to work effectively with clients whoare ambivalent about their alcohol and drug usage. Referring alcohol anddrug clients to structured treatment may not be appropriate, feasible, or possible. So what might counselors do?In this text, we explore questions counselors need to be asking in such instancesand provide information on drug terminology. Furthermore, we present interviewing techniques to increase client motivation and change.Overview of the BookThe remaining pages of this chapter outline the topics and information found in Chapters 2–14. Brief in description, they provide counselors in training and counselors anunderstanding of each chapter and are constructed to be used as a quick reference.Chapter 2: Diversity Issues in Substance Abuse TreatmentThis chapter explores cultural and gender issues, including issues faced by lesbian,gay, bisexual, and transgender (LGBT) clients as they relate to alcohol and drugtreatment and relapse prevention. Historically, addiction treatment did not address issues of race–culture, gender, or diversity. Notably, AA was co-foundedand developed by two White, European American males, which resulted in theuse of the male pronoun in much of AA’s initial writings. Because significantlyhigh proportions of women entering alcohol and drug treatment have been sexually, emotionally, or physically abused, a section on women’s issues is included inthis chapter. These issues are reviewed, and options to facilitate effective planning with substance-abusing and addicted women are addressed. Additionally,cultural awareness and race issues with alcohol and drug clients are explored.LGBT clients find difficulty in discussing their lives in alcohol and drug treatmentas well as in support meetings; therefore, methods and strategies on how to helpthese clients in treatment are addressed. In addition, clinical work with older clients and those clients with physical disabilities are explored in this chapter. Thissecond edition includes an overview of treatment issues in other countries andhow addiction is treated.This chapter prepares counselors to understand the worldview of all clients inthe counseling process. Throughout the text, multicultural, gender, and diversityvignettes with questions for discussion are presented.Chapter 3: Types of Drugs and Their EffectsAn overview of the varied drug classifications is provided in this chapter along withpossible clinical interventions. Alcohol, stimulants and other amphetamines, mari6

Drug and Alcohol Counseling: An Introductionjuana, barbiturates, benzodiazepines, opiates, hallucinogens, inhalants, steroids,over-the-counter drugs, and sedative-hypnotics are addressed. The signs and symptoms of intoxication and withdrawal risks and factors are also included. The conceptof synergism (the impact of multiple drugs and how they potentiate one another),cross-addiction (addiction to drugs in different categories), and cross-tolerance (tolerance to drugs in the same category) are outlined. Included are descriptions of thepsychotropic medications used in treating other mental disorders and the interplaywith addiction treatment. Professional literature and information on each categoryis presented, with emphasis on application to the counseling setting. Counselorswill be informed on the many classifications and the drugs in each category and theimplications for treatment and referral. An expansion of treatment protocols andmedications used with opiates has been added in this second edition.Chapter 4: Assessment, Diagnosis, and Interview TechniquesThis chapter presents information on various alcohol and drug assessment instruments that can be used during the substance abuse–dependency assessment. Theuse of motivational interviewing (MI) techniques, as developed by W. R. Millerand Rollnick (2013) are included to help counselors work with initial client resistance and ambivalence to counseling. In this second edition, we’ve expanded theinformational aspects of MI. Also in this chapter we thoroughly describe the newdiagnostic criteria stated in the Diagnostic and Statistical Manual of Mental Disorders(DSM-V; American Psychiatric Association, 2013) and the changes from the fourthto the fifth edition.Of significance is a description of how to effectively and accurately diagnoseclients suffering from a co-occurring diagnosis, including suggestions for working with a variety of personality-disordered substance abusers. Because clientsrarely have a single substance abuse–dependency diagnosis, a general understanding of the various mental disorders along with knowledge of substanceabuse–dependency criteria is necessary for accurate treatment planning. Depending on the counselor’s work setting, accurate diagnosis can be a challenge.More specifically, we discuss the issue of how to develop an effective treatmentteam even if the psychiatric resources are not in the counselor’s setting. We willexplore issues such as when and where to refer, how to use drug testing andBreathalyzers, and the use of external data and therapeutic leverage in the counseling process.After reading this chapter, the counselor will be able to understand resistance,have a clear understanding of the diagnostic criteria in differentiating betweenabuse and dependency, and will be familiar with approaches to improving anaccurate psychiatric diagnosis. In this second edition, a review of the literaturesurrounding suicide and self-harm has been included because of the rise in overdoses and fatalities involving alcohol and drugs, particularly with adolescents andyoung adults.Chapter 5: Continuum of Nonuse to Addiction:A Biopsychosocial UnderstandingThis chapter reviews the biopsychosocial approach to addiction and helps readersunderstand more clearly the process of how clients move from nonuse to addic7

A Contemporary Approach to Substance Use Disorders and Addiction Counselingtion. Additionally, information on genetics, as well as environmental–social andcultural perspectives, is explored and why some individuals appear more susceptible to addiction than others. Counselors will begin to understand the uniquechallenges that counselors face when working with this population. Building onChapter 4, we apply MI techniques to case scenarios for the reader to understandthe application of MI in the continuum.Prevention models are described in terms of their application on or along thecontinuum of substance use or abuse (i.e., clients who have not yet used alcohol ordrugs, clients who have used alcohol or drugs on occasion but are not yet dependent [at risk], and those clients presenting multiple consequences and a history ofalcohol or drug problems with or without symptoms of addiction). Significant tothis chapter is information on how to appropriately match prevention strategies inhelping clients at various points in the continuum. After reading this chapter, thecounselor should be able to understand the continuum of use to addiction and theappropriate application of prevention ideology. A graph is provided for readersto understand the continuum and how the stages of change (Prochaska & DiClemente, 1982; Prochaska, DiClemente, & Norcross, 1992), along with the work ofBronfenbrenner (1976, 1988), can be woven into a conceptual framework to workwith clients.Chapter 6: Treatment and Treatment SettingsAlthough many readers may not be alcohol and drug counselors specifically, thischapter helps counselors understand their role in the treatment process. A varietyof work settings

A contemporary approach to substance use disorders and addiction counseling/ Ford Brooks and Bill McHenry.—[Second edition] pages cm Includes bibliographical references and index. ISBN 978-1-55620-339-8 (pbk. : alk. paper) 1. Drug abuse counseling. 2. Alcoholism counseling. 3. Addicts—Counseling. 4. Substance abuse. 5. Health counseling. I.